himself mainly to arrow wounds; and, in the case of embedded arrow-heads, he advises the surgeon to await suppuration before attempting their removal, an operation which should be performed about twelve or fourteen days after the date of injury. Gunpowder should be rinsed from a wound with the milk of a woman or of a goat, the projectile, if present, being removed with the help of a sound, and the wound mollified with lotions made from gentian, turnips and other vegetables.

Towards the end of the 15th century we begin to have more extensive information touching the surgical treatment of gunshot wounds. The Buch der Cirurgia' of Hieronymo Brunschwig, printed in Strassburg in 1497,* contains both a brief description of wounds caused by firearms and advice for their treatment. Brunschwig, who was an Alsatian, relates that he learned his art of bullet extraction from a certain Hans von Dockenburg, to whom tradition attributes the cure of an obstinate wound sustained by Matthias Corvinus (1450-1490), King of Hungary, in an affray against the Moldavians. For four years, the story runs, the Hungarian monarch sought a cure and offered riches and honour to any who should heal him, until at last, in 1468, the cure was wrought by this Alsatian surgeon.†

A short chapter of Brunschwig's book tells in his quaint dialect of one who has been shot with a bullet so that the powder has poisoned the wound and the ball remains therein.' If the limb is penetrated, Brunschwig advises us to 'take a silken thread and thrust it through the sinus and draw it back and forth so as to evacuate the powder from the wound.' When the shot still remains in the wound, we must make the wound wider by cutting, . . . and then skilfully and neatly seize it with a bullet forceps (Kugelzangen) and draw it out. But, if the wound cannot be cut or enlarged, use the iron instrument called the "stork's beak " ("Storchenschnabel")' (Fig. 4 (1)). This terrible wound-dilater was in use down to modern times, and underwent modification at the hands of several surgeons in the 15th, 16th, and 17th centuries. It was often elaborated into an engine of three or four

*This work was reproduced in facsimile by G. Klein; München, 1911. †Theodor Billroth, op. cit., p. 7.

blades, constructed so as to stretch the wound in all directions, and thus permit the operator to gain freer access to the part.

Brunschwig tells us that if it should so happen that, in spite of manipulation, the wound should fail to suppurate, the surgeon may adopt more active measures; and he advises the insertion into the wound of an instrument smeared with ox or bacon fat, 'a procedure which will almost certainly produce the desired result.' The view that the formation of purulent matter in a wound is a favourable process can be traced far back into antiquity and lasted long after Brunschwig. Indeed the doctrine of 'laudable pus' did not receive its death-blow until the work of Pasteur and Lister reduced to absurdity the older theory of the evacuation of the humours.' Even Brunschwig, however, gives a hint of sounder surgical principles when he assures us that 'there is no healing without cleanliness.' He foreshadows, also, another great surgical advance by his use of a primitive form of anaesthetic or 'Toll-trank,' as he calls it, for which he gives us the prescription. The draught contains, inter alia, opium, crocus, cortex of mandrakes, ligne aloes, cinnamon, and castoreum.

Brunschwig had some idea of the ligature of vessels, and grasped to a limited extent the use of the tourniquet. His book is interestingly illustrated; and, in most of the figures, the operator or professor is shown instructing students or assistants. One of his figures is probably the earliest printed illustration of an abdominal operation.

·

A contemporary of Brunschwig was another Alsatian surgeon, Hans von Gersdorff, also called Schylhans, who gained his experience of field surgery in campaigning with his countrymen and the Swiss against Charles the Bold. He was present in 1477 at the battle of Nancy, where artillery was much in evidence. The publication of Gersdorff's Feldtbuch der Wundt-Artzney' was, however, delayed until 1517, when it appeared at Strassburg, of which town he was a burgher. The treatment for gunshot wounds advised by Gersdorff is fairly simple; the wound is to be drenched with warm hemp-seed oil to get rid of the powder, then washed with water or bland fluids, and finally treated with the universal salve 'unguentum egyptiacum.' This wonderful all-healing

FIG. 1.-AN INSTRUMENT FOR STRAIGHTENING A STIFF AND CONTRACTED JOINT (FROM GERSDORFF).

[To face p. 456.

medicine was much affected in the 15th, 16th and 17th centuries. As described by Hans von Gersdorff, it was compounded of honey, vinegar, verdigris and alum; but, as the years went on, each successive practitioner adopted a more complex formula, until at last the Egyptian unguent lost all semblance of its original composition.

Gersdorff referred to amputation, but he considered the only indication for it to be the onset in the injured limb of St Anthony's fire or, as it is now called, erysipelas. Wounds of heart, lung, stomach, intestine and bladder, he regarded as invariably fatal. Depressed fractures of the skull he did not apparently treat with the trephine, but with a fearful mechanical elevator, whose mode of action ensured certainty as regards the immediate results of the operation. Hans von Gersdorff adds to Brunschwig's 'Stork-beak' several other instruments specially designed for the extraction of bullets. He used also a 'Hock' or long bullet spoon, a Borer' or instrument to thrust into sinuses, a 'Sclang' or thick-toothed curved forceps, another form of special ball forceps, the Klotzzang,' a speculum or 'Loucher,' besides special instruments for the extraction of arrowheads. Not the least interesting part of the Feldtbuch is the inclusion of a disease he calls Lepra, but which the modern medical reader will regard as comprising cases of syphilis. The treatment of this disease was regarded until recent years as the special field of the army surgeon.

In those days, as in these, among the most difficult cases that the military surgeon encountered were contracted limbs with stiff or disorganised joints following gunshot wounds. Gersdorff illustrates for us some of the instruments used in correcting these faults. One such device appears to have been called the Narr,' a cognomen which gives him an opportunity for a punning allusion (see Fig. 1; Narr = fool, jester).

6

By far the most popular of the early writers on gunshot wounds was, however, Giovanni de Vigo (1460-1520), the medical attendant of Cardinal Giuliano della Rovere, afterwards Pope Julius II. De Vigo's book, 'Practica in Arte Chirurgia copiosa,' was first printed at Rome in 1514, a few years before Gersdorff's 'Feldtbuch'; and one of its chapters is entitled, 'De vulnere facto ab instrumento quod bombard nuncupatur et omnibus instrumentis